HomeMy WebLinkAbout1160 Cobblestone Ct - Applications/Furnace - 03/21/201802/27/2018 5:58PM FAX 9704844373
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City <7i' r (Planning, Development & Transportation
281 N. College Ave P.O. Box 580
/ • (, t, 4 {, _:.f•� .�:.'. a:!! Is 's Fort Collins, CO 80524
Phone 970-416-2740 Fax 224.6134
OVER -THE. COUNTER PERMITS ONLY
This application is to be used to apply ifor the following permits only (check all that apply). CI Air Conditioning
❑ Demolition (interior non-structural) ❑ Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log
❑ Heating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Line ❑ Photo -voltaic
❑ Ventilation ❑ Water Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and
manufacturer).
Complete all applicable information on the application. Incomplete applications will not be accepted.
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For office use only
Job Site Address (required)
Value of Constction (labor, materials, profit)
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Property Owner Name
Address
City/State Zip Phone
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Applicant Name
Address
City/State Zip Phone
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Contractor
Address
City/State Zip Phone
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Contractor City of Ft. Collins Sales Tax 7t
Are you paying taxes here or by report? ❑ Here iP Report
Sales taxnumber isrequiredbyall mntractws.
Are you paying with your trust account? M Yes ❑ No
is this a residential or commercial project? 'Residential ❑ Commercial
If residential, is it: O(Singie Family Detached ❑ Condo/townhome (single family attached) ❑ Duplex
❑ Multifamily (apartment) ❑ Garage
If commercial, is it: ❑ Bank ❑ Bar Q Church ❑ Hotel/Motel ❑ Medical office ❑ Office ❑ Retail
❑ Restaurant ❑ Other (explain)
Is this building 50 years of age or more? ❑ Yes CJ No If yes, you may need to contact Historic Preservation
If this is for a demolition permit, what year was the building constructed? _
If pnor to 1975, you will need an asbestos assessment to submit with this application.
Description of wor! _ ei
*If lawn sprinkler/backnow preventer, must list licensed plumber. If first-time A/C, must list licensed electrician,
Subcontractors: List the company name or City of Ft Collins license #
Electrician Plumber Mechanical Roofer Other
I hereby acknowledge that I have read this application and state that the above information is complete and correct. I agree to
comply with all requirements contained herein and city ordinances and state laws regulating building construction, II know that a
permit is not valid until it has been paid and issued.
Applicant: �M
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